CVS announced Monday that it plans to purchase Signify Health, a network of more than 10,000 clinicians that provides personalized assessments and care for U.S. patients in their homes, along with virtual telehealth visits. The $8 billion acquisition is a big gamble for the 59-year-old pharmacy chain. It’s also an attempt to revive a relatively old concept: the doctor’s house call.
CVS is just one of many companies, including Amazon and Walgreens, that have recently invested in home health care. The reason why is simple: The number of people aged 65 and over in the US could practically double by 2060, meaning the demand for medical care will almost certainly grow as well.
Making a medical appointment at home may be safer for people who have trouble leaving the house. The return of home visits is also part of a wider transformation in how care is delivered and, perhaps more importantly, who is delivering it. Like CVS, many of the companies investing in home health care are not traditional health care providers, and they are interested in using technology to do much more than just medical appointments at home.
CVS, for its part, has made no secret of its desire to gear up and become a tech-focused healthcare company (the chain officially changed its name to CVS Health in 2014). This plan includes closing about 1,000 of the nearly 10,000 U.S. pharmacies in the coming years, while also converting some of the remaining retail locations into clinics that can provide emergency, primary and mental health care in addition to traditional pharmacy services. The company already owns the insurance company Aetna, the prescription benefit management service Caremark, and a nursing home-focused pharmacy service called Omnicare. Fresh off the launch of a virtual telehealth platform earlier this year, CVS now adds doctors, nurses and physician assistants who also travel to people’s homes.
“The CVS concept? It’s quite a brilliant umbrella they’ve created,” explains Tara Cortes, the executive director of the Hartford Institute for Geriatric Nursing at New York University. “They really have the whole package to provide a holistic approach to keeping people at their highest potential of well-being and safe at home.”
Home visits currently make up a relatively small proportion of doctor’s appointments in the US. Doctors used to travel directly to patients’ homes — before cars, often via horse — but the primary care practices that patients traveled to became the dominant way people received health care in the 20th century. While home visits made up 40 percent of doctor-patient encounters in 1930, this was only 10 percent of those encounters two decades later, and just 0.6 percent in 1980, according to a survey. New England Journal of Medicine study. Today, home visits are primarily an option used by those with certain health conditions, patients recovering from hospital stays, and the elderly who would benefit from home visits to doctors. Often, the people who use these services have Medicare Advantage plans, which allow people to take out private coverage, including for home care, in addition to their Medicare plans.
Some think home medical appointments are in the throes of a technology-enriched renaissance. The rise of telehealth, along with new connected devices — remote monitors, for example, can automatically keep doctors informed of patients’ vital statistics — has made medical appointments at home. easier to facilitate. In general, sending a nurse or doctor to a patient’s home can be a more comfortable experience for the patient, and it also gives clinicians an insight into a patient’s daily life and practices. Some have speculated that the kind of data Signify could potentially collect, including information about what patients eat and their relationships at home, could make healthcare delivery more effective, though it will certainly raise real data privacy concerns as well.
But, like all things, there are real drawbacks. Some experts say the massive expansion of large pharmacies to many different aspects of healthcare could penalize existing independent pharmacies. There are also broader antitrust concerns. The FTC is already investigating Amazon’s plans to buy primary care network One Medical, and competition experts have warned that CFS may face similar hurdles in its plan to buy Signify Health.
“CFS appears to want to dominate all facets of healthcare with this acquisition, and home visits are part of that ambition,” explains Stacy Mitchell, co-director of the Institute for Local Self-Reliance, a nonprofit organization. that advocates local solutions. “There is real concern about the implications of that dominance in an industry that is already highly consolidated.”
Still, CVS is far from the only company involved. Amazon also offered to buy Signify, and the employer’s health care program, Amazon Care, offered an in-home appointment option before shutting down earlier this year. Last week, Walgreens completed a $330 million investment in CareCentrix, a platform that enables home care for patients after they are discharged from hospitals. In 2020, the insurance company Humana bought a $100 million stake in Heal, a telemedicine and home health care service already available in several states. The company already owns the home care provider Onehome.
Only time will tell whether CFS’ proposal passes regulators’ scrutiny, and there’s no guarantee that the company’s foray into home health care will ultimately be popular with patients. Yet it is already clear that the return of the home visit is not really a legacy. Instead, it’s just part of a new era of healthcare, an era where traditional doctors’ offices and pharmacies are far from the only players. That’s “competition,” explains Cortes, “that the traditional health care system has never had.”
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